[Congressional Record Volume 155, Number 143 (Tuesday, October 6, 2009)]
[House]
[Pages H10494-H10500]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Connecticut (Mr. Murphy) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. MURPHY of Connecticut. Mr. Speaker, I'm glad to be here on the 
House floor this evening, joined by many of my colleagues representing 
the class of 2006, to come down to the floor this evening to talk to 
our colleagues on both sides of the aisle about an issue that doesn't 
discriminate between Republicans and Democrats, an issue that doesn't 
care whether you're liberal or conservative. It is the lack of access 
to affordable health care in this country. The voters of this Nation 
gave the House and the Senate and the President a mandate last 
November. It was to come here and do something that has not been done 
in the modern history of this government, to finally make fundamental 
reform of our health care system so that the people that we represent 
do not go bankrupt by the current system, and the government that we 
are constituted to protect doesn't go bankrupt because of health care 
costs.
  So we're here to talk this evening about what we think is an amazing 
opportunity for this House and for this country to pass a health care 
reform bill that, at the same time, expands coverage to people that 
either don't have health care insurance or today have inadequate health 
care insurance and, in doing so, reduces the cost of health care for 
all Americans and all of the countless businesses, small and large, 
that are struggling to pay for health care costs.
  Mr. Speaker, I'm going to turn this over to my colleagues to begin 
the discussion. But before we do, I just want to share one important 
chart and statistic with my colleagues. This is a chart that simply 
shows what has happened over the last 10 years to health care costs in 
this country, a 119 percent increase in the premiums that families and 
businesses are paying. During that same time, a 117 percent increase in 
the money coming out of workers' pockets to pay for that health care. A 
119, 120 percent increase, let's round it off, in health care costs for 
businesses around this country.
  That is unsustainable. And what it has meant is that during that 
time, any additional money that businesses have made over the last 10 
years has largely gone not to workers' pockets, not to increased wages, 
but to pay health care bills. So we'll talk tonight about a lot of the 
visible costs of our very broken health care system, the scars on the 
outside that people have due to our neglect of the problems in our 
health care system.
  But there are a lot of invisible costs as well. And what this chart 
very clearly shows is that when employers, over the last 10 years, are 
paying 120 percent increases, that means that a lot of workers out 
there aren't seeing raises, or are only seeing 2 percent when they 
should be getting 5 percent because their employer is sending all of 
that money into their insurance plan. And so we're going to talk about 
that tonight. We're going to frankly also talk about a lot of the 
mythology that's out there.
  We had a speaker on the Republican side of the aisle earlier tonight 
come down here and use the now familiar Republican talking point of the 
government takeover of health care. Well, I think if any of our 
constituents out there do what every Member of Congress should do, 
which is read the bill, they'll find that there is no truth in that 
statement. That statement, though is anchored in a 28-page memo that 
made the rounds around the House of Representatives earlier this year 
by Frank Luntz, a very well known Republican pollster who laid out to 
Republicans how they could kill health care reform.
  He said very clearly, don't pay attention to the details. Don't pay 
attention to the substance. Just say government takeover again and 
again and again. That memo is strewn with one piece of advice: If you 
say government takeover, you can stop health care reform from 
happening. And if you stop health care reform from happening, you can 
preserve the status quo.
  That's what's happening here. Talking points and sound bites designed 
to stop health care reform from happening, designed to stop the reforms 
that will pass on lower costs to our constituents, that will guarantee 
access to people that don't have it, that will end these discriminatory 
practices of insurance companies. That's the agenda that is going to 
play out on the House floor over the coming weeks and months, an agenda 
anchored in reform, anchored in cost-cutting, anchored in expanding our 
access and a political agenda designed to use talking points and sound 
bites to stop health care reform from happening.
  I'm glad to be joined here on the House floor by several of my 
colleagues to talk about the stakes of this debate, to talk about what 
is really in the bill versus what folks are claiming is in there. And 
we have some great leaders in this effort joining us tonight, led by my 
good friend from Colorado, Representative Perlmutter.
  Mr. PERLMUTTER. And I thank my friend, Mr. Murphy, for kicking off 
tonight. And let's start where you were ending, about the status quo. 
Republicans in Congress just want to maintain the status quo. And I 
know in Colorado that's unacceptable, because what we've seen, like 
your chart, but even more so, the acceleration of the cost to keep 
people healthy and well is going through the roof. Whether it's a small 
business or a family, an individual, the premiums are going up. The 
deductibles are going up. I know at my old law firm, where it's in a 
position now where, after decades of providing coverage to everybody 
who works in the firm, there's a real question whether the firm can 
afford it anymore.

                              {time}  2015

  That's just not right--not in a country like our country. Not in 
America. We can do better than that. Change is what needs to take 
place. The status quo is no longer an option.
  There's a fundamental flaw with the system that we have right now in 
that it allows discrimination against people who have prior health 
conditions. And that's just wrong. It's something that should not be 
allowed here in America.
  I have a daughter with epilepsy. So, for me, it's a very personal 
kind of setting. She's a wonderful kid. She's no longer a kid. She's a 
young woman, college graduate, but still has seizures from time to 
time. She's not insurable unless she's in a big group insurance 
setting. She can't get insurance. She didn't ask to have epilepsy. But 
she's discriminated against because she has it.
  That's just got to change. And I know in my district and in Colorado 
more than 80 percent of the people want to see change so that people 
with prior health conditions, preexisting conditions, get coverage and 
are not discriminated against.
  We have a fundamental flaw in our health system today that has to be 
corrected. It's wrong. And it's probably unconstitutional under the 
equal protection clause of the 14th Amendment to our Constitution. 
We've got to change that.
  So we need to rein in costs for small businesses and for individuals. 
We need

[[Page H10495]]

to eliminate discrimination against people based on preexisting 
conditions. But there's a third component to this that I really think 
does offer hope and promise when we bring about this change and that is 
the research that we have going on in prevention, health and wellness.
  There are some things coming down the pike if we continue to do 
research that will really advance medicine when it comes to cancer and 
heart disease which will help individuals and their quality of life and 
it will help this country rein in the costs that we see just growing 
every single day. This is a challenge that we must take, that we must 
tackle. We cannot shrink from it. America doesn't shrink from tough 
problems. We tackle them.
  Our friends on the other side, the Republicans in Congress, they like 
to avoid this. They're not willing to take on tough issues. We are. We 
are going to take this on. We are going to change the health care 
system for the better of America and Americans. And we're going to do 
it this year.
  With that, I yield to my good friend from New Hampshire (Mr. Hodes).
  Mr. HODES. Thank you.
  I am glad to be with you tonight to talk about what is perhaps the 
most critical issue we face as a nation if we are to thrive, if our 
economy is to prosper again, and if we are to deliver to the American 
people, people of my State of New Hampshire, what they have been long 
asking for, which is real reform on health care.
  We are going to lower costs for everybody, we're going to deliver 
better quality care, and we are going to put the people of this country 
back in control of their health care. Because right now, with all the 
noise that's been out there--and you've referenced the notion that's 
been put forward of a government takeover of health care. Well, nothing 
could be further from the truth. But at the moment what is between us 
and our health care are insurance company bureaucrats who are making 
life-and-death decisions and are able to discriminate against the 
American people based on profits for the insurance companies. That 
simply has to end.
  I'm going to tell you a story. It's a story of how change happens. 
It's a story of tragedy and it's a story, ultimately, of triumph. But 
it talks to the issue of what kind of situation we're in with our 
insurance companies.
  In my district in New Hampshire at Plymouth State College there was a 
young woman named Michelle Morse. She was in her senior year. Beautiful 
young lady, 3.6 grade average, an honor student. She was looking 
forward to graduating at the end of her senior year and moving on with 
a happy life.
  She woke up one day with a stomachache. By the next morning, she was 
diagnosed with cancer--serious, aggressive, fast-moving cancer. And her 
doctors said to her, You've got to leave school and take a leave of 
absence in order to get treated for your cancer.
  And so she and her family--because she was on her family's insurance 
policy--went to their agent. They called their insurance company and 
they explained the situation and they said Michelle has to leave school 
to get treated for cancer.
  What came back from the insurance company was, Well, that's up to 
you. That's fine. If Michelle needs to leave school, she leaves school. 
Let her take a leave of absence. But if she's not a full-time student, 
if she takes a leave of absence, she will no longer be covered by your 
insurance.
  The Morse family couldn't believe it. But, sure enough, buried in the 
print of that insurance policy was exactly that--unless Michelle was a 
full-time student, she wouldn't be covered.
  So they made the difficult decision. Michelle stayed in school. She 
took three courses of chemotherapy. She finished with honors--an 
incredible achievement. And sadly, Michelle died.
  Now her mother, Ann Marie Morse, is a teacher. She's a teacher that 
teaches elementary school kids. She had never been involved in politics 
a day in her life. But she decided that what happened to her daughter, 
what happened to her family, was wrong. She decided that she would make 
it her business to make sure that what happened would never happen to 
another family again.
  Now this is just a very small slice of the larger debate about health 
care; a very small piece of what it takes.
  So first, Ann Marie Morse, a teacher, went and lobbied everybody in 
Concord, New Hampshire, the capital of New Hampshire and got a State 
law passed, thanks to her efforts, that said college students can take 
a 1-year leave of absence without getting knocked off their parents' 
insurance policies. But that wasn't enough because it's Federal law 
that controls. ERISA controlled. And ERISA needed to be amended.

  So I worked with Ann Marie Morse. We worked here in Congress on a 
bipartisan basis. We got every health insurance association, we got 
everybody involved, because even the health insurance companies knew 
that what happened to Michelle Morse was wrong and it shouldn't be 
allowed to happen. Even the insurance companies knew that.
  So with Ann Marie Morse in the gallery of this House, the House by 
unanimous vote passed Michelle's Law to allow college students to take 
a 1-year leave of absence for serious medical conditions without 
getting knocked off their insurance. Because the Morse family had 
nowhere to go because now Michelle couldn't find other insurance. She 
had a preexisting condition. And they couldn't afford private 
insurance--single, private, individual insurance--because it was just 
priced too far out of the market because the insurance companies had a 
monopoly. There was nowhere to go. She couldn't get Medicaid. She 
couldn't get Medicare. She couldn't find any alternative. She had to 
stay in school.
  So when the House passed it, then the Senate passed the bill. 
President Bush signed it into law. And this Friday, October 9, 
Michelle's Law becomes the law of the land. So that what happened to 
Michelle Morse will never again happen to any college student in this 
country.
  Thousands, thousands of college students are affected. Mike Castle on 
the other side of the aisle was the cosponsor. He understood. A 
responsible Republican understood that what was wrong shouldn't happen 
again. So he worked on the law because he had somebody in his district 
who it happened to. I'm betting if we all look, all my colleagues who 
are here tonight, we'd find people in our districts, other people that 
this has happened to.
  It took 2 years to get that done, this small slice of the health care 
problem. Two years. And now we face a bigger test. Are we going to hold 
the insurance companies responsible for reasonable action on the part 
of the insurance companies?
  The insurance companies now are regulated by a patchwork of 50 
different State rules and regulations. Fifty different schemes for 
regulating. We are talking about, finally, for the first time, saying 
to the insurance companies, as the people of the United States of 
America, No discrimination for preexisting conditions like diabetes or 
heart condition or cancer, no dropping your coverage because you become 
sick--both of the things that happened to Michelle Morse, which 
Michelle's Law is designed to affect for that small slice of college 
kids.
  No refusal to renew your coverage if you paid in full and become ill. 
No more job or life decisions made based on loss of coverage. No need 
to change doctors or plans if you like the coverage you have. No copays 
for preventive and wellness care. No excessive out-of-pocket expenses, 
deductibles, or copays. Yearly caps on what you pay, but no yearly or 
lifetime cost caps on what insurance companies cover.
  These are reasonable rules that we are finally going to set down on 
the insurance companies. Reasonable rules. The kind of rules of the 
road that the American people deserve and that our health care reform 
plan is going to deliver so that what happened to Michelle Morse will 
never happen to any family or anybody, whether they're in or out of 
college. It's time for real reform.
  With that, I'm going to turn it over to my colleague, John Sarbanes 
of Maryland.
  Mr. SARBANES. Thank you very much. I appreciate it. I want to thank 
Congressman Murphy for bringing us here tonight to talk about this 
very, very important issue.
  I just had a couple of things I wanted to talk about. First of all, 
we're bringing this thing across the finish line very soon. I know a 
lot of folks are excited about that. But I want to make sure people 
understand we are not

[[Page H10496]]

limping across the finish line. We're going to cross that finish line 
with a burst of energy that comes from understanding that we have 
finally addressed so many of the grievances that millions of Americans 
have had with this health care system for so many years.
  There are a lot of things we can talk about that are wrong with the 
existing system. And it's important to point those out. But we need to 
spend just as much time about the good things that are going to happen 
if we can get this health care reform passed.
  There's so much in all of the core components of the health reform 
legislation that has come out of all the different committees, both in 
the Senate and the House--there's so much in there that addresses these 
concerns people have had for so long.
  I want to talk a little bit for a moment about the Medicare portions 
of this bill, because the other side has presented a very sort of 
cynical scenario about what is going to happen to the Medicare program 
under this bill.
  In fact, every effort that we've made in shaping these bills when it 
comes to Medicare has been to strengthen the program, to make sure that 
the Medicare trust fund lasts longer, to make sure that we're looking 
after seniors, as we should, and protecting their interests. So let me 
talk a little bit about that.
  We are going to parts of the Medicare program where we can find 
responsible savings--and I'll be more detailed about that in a moment--
but just conceptually understand that those savings are then being 
turned around and reinvested back into the Medicare program.
  So, in other words, this is not a case of finding savings that go 
someplace else. The savings that we're looking to get out of the 
Medicare program from a more responsible approach is going to be taken 
and turned right back into an investment in the Medicare program.
  So where are we getting some of the savings? Well, there's something 
called preventable readmissions to a hospital. This is a situation 
where somebody is discharged from the hospital too quickly. Often this 
occurs because the insurance companies, who don't want to pay to keep 
people in the hospital because they're trying to keep their costs down 
so they can pocket more of the profits that they get from your premium 
dollar, they push people out of the door too quickly. Well, that means 
folks are leaving the hospital before their situation has been 
completely stabilized or addressed--with what consequence? The 
consequence that a few days later, a week later, 2 weeks later, 
suddenly they've got complications. They've got to come back into the 
hospital. That's not good for them, but it also costs the system a lot 
of money.
  The estimates are that you can save billions of dollars if you insist 
on better thinking at the point of discharge, so that when people leave 
the hospital, it's time for them really to leave the hospital and their 
situation has been addressed so they're not going to have to be 
readmitted a few days later. We're taking those savings and we're 
reinvesting them in the program.

                              {time}  2030

  You all remember the stories we used to hear about years ago about 
the $600 toilet seat that the Pentagon used to purchase as an example 
of wasteful spending. Well, there was just an article the other day in 
the newspaper about a company that makes motorized wheelchairs. It 
costs them about $1,000 per wheelchair to make this. They've been 
turning around and selling it to the Medicare program for $4,000. A 400 
percent markup.
  Well, that's wasteful. We can rein that spending in. We can take the 
savings, and we can plow it into things that make sense for the 
Medicare program. What are some of those reinvestments that are 
important? Number one, we are going to make sure that physicians get 
reimbursed at the level they should. Many seniors I have talked to have 
expressed alarm because either they or people they know have talked to 
physicians who say, We can't afford to stay in the Medicare program any 
more. We're going to opt out.
  Well, when President Obama came in, he said, We're not going to play 
games any more with physician reimbursement. We're going to reimburse 
them fairly. And this bill does that. This bill makes sure that a cut 
of up to 20 percent that was supposed to occur, with respect to 
physician reimbursement, that's not going to happen. It will keep more 
doctors in the network. That is going to be better for our seniors.
  Another place we are reinvesting the savings is to begin closing the 
doughnut hole in the part D prescription drug program, which has really 
hit many seniors between the eyes when they have to come out of pocket 
to cover their prescription drug costs. We are going to begin to phase 
in filling in that doughnut hole so that coverage is there, another 
benefit of finding savings in one place and reinvesting it in another.
  The last thing that I mentioned that is very important is we 
recognize that there are certain preventive kinds of services that make 
absolute sense, and we don't think that seniors should have to have 
copayment related to those services anymore.
  So what's an example? The initial exam. Under the new bill, no longer 
will there be a copayment requirement. You don't have to come out of 
pocket for that service. Glaucoma screening, no longer will there be a 
copayment requirement, and other services like this that make sense 
because they save the system money overall, and they are good for the 
individual patient.
  There is so much about this bill that makes sense. There is so much 
that we fashioned based on the recommendations of experts and ordinary 
citizens who came forward and said, We need to see a change. That's 
what we've done. We've answered that call. I am very excited about the 
prospects of crossing the finish line with that burst of energy that 
says, We have accomplished something that the American people sent us 
to do. That's what we are going to be doing over the next few weeks.
  I really appreciate the opportunity to speak here this evening, and I 
now yield to my colleague from Vermont, Peter Welch.
  Mr. WELCH. Thank you very much. It's a pleasure to be here. It's an 
incredible debate that we have. It's long overdue. We have to have 
affordable, accessible health care for all our citizens, and we have to 
have it be affordable for our employers and our taxpayers. We don't 
have that now. You know, right now in 2009, health care spending eats 
up about 19 percent of every family's income. Under present trends, 
that would go up to 31 percent in 2019, and anybody who is working for 
a paycheck, a wage or a salary, has faced over and over again year in 
and year out that grim choice of accepting a very small raise--if 
they're lucky enough to get a raise--in exchange for hanging onto the 
health care benefits that they have.
  So the real challenge of health care is to make it affordable and 
accessible for the people who have it, but for whom the quality of 
health care and the cost of health care is slipping beyond their reach.
  Now, there are three elements to the health care bill: one is 
insurance reform, two is extension of coverage to the uninsured, and 
three is a public option. As my friend from Connecticut (Mr. Murphy) 
mentioned, insurance reform is overdue. The insurance companies make 
their money, and a lot of it, not by paying claims, but oftentimes by 
rejecting claims. Not by covering everyone who needs coverage, like my 
friend from Colorado's daughter who has a preexisting condition, but by 
writing policies to exclude folks who have a preexisting condition or 
illness or by refusing to continue insurance for somebody that was 
covered but gets sick and then needs it.
  You can't have a health insurance system that operates that way 
because at some point each and every one of us is going to need health 
care coverage. And if health care insurance companies that are 
supposedly getting paid to provide coverage reject us when we need it 
so they can pad their bottom line, it's good for them, but it's not 
sustainable for us.
  So health insurance reforms are immensely important. Anybody who has 
had to use their health care coverage has probably run into the hassles 
that they've had to deal with, with the pages and pages of billing, 
with the disputes about whether a particular service is or is not 
provided, even though it was recommended by your physician; and anybody 
who's talked to their own physician about the frustrations in that 
office, all the back-office personnel that they have to have just to

[[Page H10497]]

process these claims, knows that it's a nightmare of confusion, 
incredible inefficiency and very, very expensive.
  Now, the sad truth is that this system is as inefficient and 
frustrating for doctors as it is frustrating for fathers, mothers and 
families. It works great for the insurance companies. What we've seen 
with insurance companies is that they're making a lot of money. The 
head of Aetna one year made $24 million in 1 year. And for what? It's 
to process claims. The work is done by the medical providers, by the 
nurses, by the hospitals; and the insurance companies are processing 
claims. It's something that needs to be done.
  But $24 million for the head of the company, where much of what 
they're doing is slicing and dicing who they'll insure in order to 
boost up those profits? We've got to change that. We have got to have a 
system where your health care dollar is paying for your health care 
needs, not for the $24 million salary of the head of Aetna.
  You know, even in my own State of Vermont, which is very small, and 
we don't have these huge executive salaries, by and large, the head of 
Blue Cross/Blue Shield, who was there for 9 years, when he walked out 
the door, he left with $9 million. That's unbelievable in Vermont.
  Our farmers are struggling to hang onto a way of life, our workers 
are working a second and third job to try to make ends meet. When they 
have to use health care, the can't afford the copay and deductible. 
Oftentimes they are pulling back from getting the care they need.
  So one of the major elements of this health care reform is really 
cracking down on insurance company practices that, yes, work fine for 
them but are digging a deep hole for the American economy, families, 
and businesses. Health care reform is going to require that all 
insurers compete on a level playing field, that they offer policies 
regardless of preexisting condition, that they don't have a lifetime 
cap on what your benefits are if you get an illness that requires 
significant care, that they can't yank your insurance because you need 
it.
  Then you're going to have insurance companies competing for your 
business on the basis of the service and the value, not on the basis of 
how cleverly they can write their policies to surprise you when you 
think you're going to get it. So insurance reform is a major component. 
Second is extending coverage to the uninsured. More and more folks are 
becoming uninsured. Obviously, if we can extend affordable coverage to 
them, it's very good for them. But, Mr. Speaker, it's very good for any 
of us who have coverage because it means about an $1,100 savings for 
each and every one of us.
  Finally, is the public option. There has been a lot of debate about 
that, but what it's about very simply is extending choice to you and me 
so that if we want to select a public option insurance program that 
competes on a level playing field with the private insurance companies, 
we can. It also is not a cram-down for our providers. Our doctors, our 
hospitals, our medical care folks, they can decide yes or no to be in 
that public option. So this is a choice. It's adding a choice for us. 
It's adding a choice for our medical providers, and it's going to 
create some competition for the insurance companies who, in all candor, 
have been running roughshod over the American consumer and our small 
businesses for years.
  So I thank my friend from Connecticut for bringing us together, and I 
yield back to you.
  Mr. MURPHY of Connecticut. I thank my friend from Vermont. He talks 
about the public option. It gets a lot of attention out there. A lot of 
rhetoric gets thrown back and forth on the news networks at night, the 
cable TV shows, and right here about the public option. I think 
President Obama, in his speech before this Chamber, said it right: this 
isn't about ideology. A public option isn't about a liberal philosophy 
versus a conservative philosophy. The public option represents our best 
chance to start holding private insurers accountable and putting some 
real downward pressure on premiums. That's what we're all about. I 
mean, there should be total bipartisan agreement on that basic premise, 
that health care reform should be about bringing down the cost of 
premiums for all of our constituents.
  Now, maybe there are a few people here who are so in bed with the 
health care industry that they like the fact that patients and 
consumers are paying through the roof for health care insurance and 
drugs and devices. But I think for most of us on both sides of the 
aisle we want to get to lower premiums, and what President Obama said, 
which I think laid it out pretty clearly, he said, I am for a public 
option because it's the best chance we have to put some pressure on the 
private insurers to bring costs down. But he said, If you can find me 
something else that does that, I am for that too or I'm for that 
instead. I agree.
  I'm not for the public option because I think that the government has 
to have an insurance plan that's available to individuals because that 
is a baseline of my political ideology. I'm for it because that's the 
best way to bring down cost. And that's not just me saying that. That's 
the Congressional Budget Office. The Congressional Budget Office, when 
analyzing the House and Senate bills, says that having the choice of a 
public option in that exchange that any small business or individual 
could choose is a real pressure point as a nonprofit plan that doesn't 
have to pay marketing costs, advertising costs, big CEO salaries and 
doesn't have to make a return on its investment.
  A nonprofit plan will reduce the cost of the bill and reduce the cost 
to our health care system by $100 billion. The whole bill together 
every year costs about $100 billion. So the public option alone 
essentially brings down the cost of the bill by the equivalent of 1 
year of health care reform. So I think that if our friends on the 
Republican side of the aisle want to say ``no'' to the public option, 
well, that's their right to do so. But I think that they should come to 
the table with an alternative to try to deliver some cost savings to 
our constituents.
  Now, maybe I oversimplify things when I say that this is about reform 
versus no reform. I'm sure there are people on the other side of the 
aisle that want to do something. But we have yet to see a reform plan 
from the Republicans that can prove to us that they're going to be able 
to lower costs for our constituents. I think once they do that, Mr. 
Perlmutter, we can have a real debate.
  Mr. PERLMUTTER. I thank my friend from Connecticut. Let's talk about 
why this works, why this concept works. You have millions of people out 
there, small businesses and individuals, who can't get insurance today. 
It's just too costly. They don't create a big enough pool. The 
actuaries say this doesn't work. You put them in one big pool like the 
Federal Government, like State governments, like Boeing, like some big 
company that can go to insurance companies, go to other types of 
mechanisms and really drive down the cost per employee or the like.

  So we create a marketplace. We call it an exchange in this bill, but 
there is a marketplace for small businesses and individuals to go to. 
They're going to be able to select from private insurance companies, 
Blue Cross/Blue Shield, Aetna, CIGNA, United Health and the like; but 
there will also be another choice, another option which is being called 
the public option, but it gives another choice for consumers, another 
choice for small business, another choice for individuals.
  Because there are now millions of people in the pool, it's going to 
be something that many companies would like to have. They would like to 
be able to attract those kinds of customers, get new paying individuals 
into their pool. We think that that's going to drive down prices, or at 
least contain the costs that all of us have seen go up and up and up. 
So I think that there is a real opportunity for us, both in terms of 
cost to the public as well as cost to private business, to really rein 
in these costs and make sure all Americans are covered by insurance in 
case something bad happens, but also make it so it's affordable for 
each and every one of us.
  With that, I will yield to my friend from New Hampshire because he 
looks like he has something he wants to add.
  Mr. HODES. I think it's a very important discussion because really 
what we're talking about, Mr. Speaker and my colleagues, is consumer 
choice. It is a hallowed principle here in this country. The American 
consumers

[[Page H10498]]

want choice. And what we are doing here with the House bill is really 
designing a uniquely American system that delivers more choice, more 
competitiveness, and more control for consumers of health care. It's 
especially important in my State of New Hampshire because in New 
Hampshire, small business is big business. Some 65 percent of people in 
New Hampshire are employed by small businesses.
  What has happened in small business on the health care front is a lot 
worse. As bad as it is for many individuals and big businesses, for 
small businesses, it's a lot worse. In the same time that individual 
premiums have gone up 100 percent or 117 percent, for small businesses 
in this country premiums are up 129 percent. Since the early 1990s when 
68 percent of small businesses offered health care, we are now seeing 
that drop off; whereas today it's about 38 percent of small businesses 
who are able to offer health care to their employees because the costs 
are simply too high. There is not enough choice in the marketplace.

                              {time}  2045

  So what we are doing is what many of us talked about to our 
constituents, which is saying we think that you folks ought to have the 
same kind of choices that we have as Members of Congress. If an 
exchange, the choice, is good enough for us, it ought to be good enough 
for you. And what the exchange does is finally deliver stability and 
security and choice. Stability, security, and choice.
  It's the security of knowing that if a small business can't find 
private insurance that they like--and, by the way, what's really 
critical to say is if people like their insurance, there is nothing in 
this bill, nothing that says you've got to give up your insurance. You 
keep your insurance if you like it. But if you don't, you have the 
option. You have a choice and the security of knowing that there is a 
consumer choice provision. It's called public option, consumer choice, 
available to you that will insure you on a level playing field with 
competitive provisions and competitive costs that means you will be 
able to find insurance. That's what is critical.
  Mr. MURPHY of Connecticut. Reclaiming my time, I think we need to get 
at where the Republicans are coming from here because a lot of them 
just hate the public option. They hate it because apparently 
government-run medicine, a government-administered plan, shouldn't be 
an option for our constituents. They just do not want people out there 
to have the choice of a publicly sponsored plan. But then when you ask 
them whether it's still good enough for people that are 65 or older, 
no, Medicare is fine. We like Medicare. Well, how about is it good 
enough for our soldiers who are fighting for us overseas? No, it's good 
enough for our soldiers. What about for our veterans? No, government-
sponsored medicine's good enough for our veterans. What about for 
Members of Congress? Well, yes, I want it for Members of Congress.
  Well, publicly sponsored insurance is good enough for seniors. It's 
good enough for veterans. It's good enough for soldiers. It's good 
enough for public employees, for Members of Congress. All we want is 
for our constituents to have the ability to decide whether it's good 
enough for them, too. That's the choice that you're talking about, Mr. 
Hodes.
  Mr. HODES. Thank you. And that's exactly the point. We are simply 
saying that it's time for everybody in this country to have real choice 
in their health care because I trust the people of this country to make 
good choices when they have the choices to make. And I find it somewhat 
surprising that my colleagues in this Chamber, most of them across the 
aisle, say it's good enough for me, but what I've got, oh, no, you 
don't need it, you don't want it. Let's just leave it all to the 
private insurance companies. Let's just leave it all there.
  I don't know what's going on with that, but I would think certainly 
choice is the right way to go. And I can't imagine any constituent, any 
person we represent, wouldn't want more choice in their health care 
because we thrive on choice, and our competitive system in this 
country, our economy thrives on competition. So having it out there 
where private insurance companies, now there are some real rules. 
Folks, you're going to have to compete on a level playing field with 
the people of this country. Here's our choice, and the people of the 
country get to make the choice.
  I think it's a really important statement that we are making in terms 
of trusting the American people to make the right choices if they have 
the right choices, and it's high time that we gave it to them.
  Mr. WELCH. If the gentleman will yield, one of the things that I hear 
from a lot of Vermonters is that they're frustrated that in Vermont 
there are only two or three insurance plans that they can choose from. 
And a lot of times people say what they'd like to do is buy, or have 
the opportunity to buy insurance from out of State. And the reason that 
many States don't do that is that the private insurance companies, 
including some so-called nonprofits, by and large dominate their local 
market areas. So the frustration that many Vermonters have, very 
limited choice about what insurance they can buy, that's a frustration 
folks have in Texas, in Colorado, in New Hampshire, in Connecticut, all 
over the country.
  Now, we regulate insurance with a set of rules that levels the 
playing field that applies to them and to the public option. So when 
you as a consumer purchase a policy, you can have some confidence that 
you actually are going to get coverage for your wife, for your 
daughter, for your husband. Then that will create the circumstances 
where we will have competition. And you know what? The insurance 
companies don't like competition, and they have been very good at 
restricting it. And then when you deny that choice and you deny 
competition, the prices, in fact, do go up. The market power of the 
insurance companies to boost prices, the pharmaceutical companies to 
boost prices beyond what the competition would allow if there were a 
freer market is costing the American people an awful lot of money.
  So we add a level playing field, a new choice of a public option 
that's the choice of you from Colorado, me from Vermont. It's going to 
create competition that is, as many people know from their own 
experience, going to drive down costs and we hope improve quality, Mr. 
Perlmutter.
  Mr. PERLMUTTER. I appreciate my friend from Vermont.
  I think within the system, the insurance companies have done what 
they are supposed to do. They're supposed to maximize profits for their 
shareholders. So I don't blame them. I think that we need to change the 
system, and that's what we're doing. And I guess I have confidence in 
them to really deliver health care insurance and coverage to people at 
a much more affordable level. I think they're going to be able to 
compete just fine. The system right now doesn't really mandate that or 
require that of anybody.
  So we have got to take a look at a whole variety of these insurance 
reforms so that everyday Americans aren't placed into having to go to 
the emergency room as their first place of care. I mean, if you want to 
talk about the most expensive way to deliver health care to Americans 
across our Nation, it's if they have to go to the emergency room 
instead of to their doctor or instead of to the local clinic. To go to 
the emergency room drives up prices like crazy. That's got to stop, and 
that's what we're going to change. That's the reason we are willing to 
tackle a very tough subject.

  The last time America and Congress really addressed the health care 
system in this country was 44 years ago in 1965 with the Older 
Americans Act. This is not easy to deal with this. A lot of people have 
different opinions. The health care system touches each and every one 
of us. But we are not going to shrink from this. We have to tackle it, 
and we are. We're going to tackle it in a way that it improves the 
system and improves the lives of everybody across the country.
  And my friend from Connecticut, I would like to say that we have most 
of New England represented here with Vermont and New Hampshire and 
Connecticut, and the New England Patriots are playing the Broncos on 
Sunday, and I'd wager, although that's probably something I shouldn't 
do on the floor of the House, but my guess is my Broncos are going to 
defeat your New England Patriots.

[[Page H10499]]

  Mr. MURPHY of Connecticut. Mr. Perlmutter, I don't really care. I'm a 
New York Giants fan. So you can have that bet with somebody else. But I 
like the fact that you just lump all of us New Englanders all in 
together that we believe and think the same things. We're diverse, 
despite what you may think.
  Mr. Perlmutter, let me back you up on your discussion on what 
insurance companies are doing now. You're right. Insurance companies 
are playing by the rules today, and they've got shareholders, they've 
got investors. In the end, they've got to put a return out there for 
the people that are investing in their companies. That's why they call 
the money they spend on health care ``medical loss,'' because to them, 
as a business, that's a loss. Now, that doesn't mean that these are bad 
people that are running the business. It doesn't mean that they don't 
want to keep people healthy. But in the end, every dollar they spend on 
health care is less money that they can return to their shareholders.
  So to try to gain a competitive advantage against each other, they 
engage in these practices, like keeping out people that are sick and 
charging more for people in their plans when they get sick, rescinding 
policies when you get sick because you didn't cross your ``T'' or dot 
your ``I.''
  But, frankly, Mr. Perlmutter, a lot of the insurance companies that 
are part of the health care reform debate don't really have a problem 
with the rules changing with respect to preexisting conditions and 
rescission, because as long as they apply to everybody, as long as none 
of their competitors can get an advantage over the other by excluding 
sick people or charging more for sick people, then they're okay, as 
long as everybody's doing the right thing.
  Frankly, that's why it's bewildering to me that we are still sitting 
here today having not done this 10 years ago, 20 years ago. And it's 
why I doubt some of my Republican friends who all of a sudden are for 
these reforms, because they had 12 years when they controlled the 
House. They could have done it during any of that time.
  So I think there are clearly places, as Mr. Welch outlined, where we 
are going to depart from the insurance companies. They don't want this 
competition from the public option. They don't want to have that 
pressure for their costs to come down. But I think there are going to 
be some places where we can get some agreement here. And my hope is 
that as we try to get to the finish line, that we set the lines in the 
sand where we're not going to be able to compromise with the health 
insurance company, with the drug industry, but we also understand there 
are going to be some places that we can come together here on, Mr. 
Hodes.
  Mr. HODES. Thank you. I want to speak to the importance of finding 
common ground if we can find it, because health care is not a partisan 
issue as far as I'm concerned and I think most of us are concerned. 
Democrats need doctors and hospitals. Republicans need doctors and 
hospitals. Independents need doctors and hospitals. We are all in this 
health care system together. And I would hope that my colleagues on the 
other side can begin to put aside the name calling and fear tactics 
that have characterized so much of the debate and speak directly to the 
real needs of the American people for a system that delivers stability 
and security, that delivers real choice in health care, that keeps the 
good that we have in the system because we have terrific hospitals and 
terrific doctors who are laboring under real impediments to delivering 
high-quality care.
  If you think about what the typical doctor has to go through to fill 
out the forms for the insurance companies, and the stories that I have 
heard from my physicians in New Hampshire about the advocacy and 
fighting that they have to do just to deliver basic health care to 
their patients because of all the forms and the paperwork and the 
bureaucracy and administrative costs that go into it, you begin to get 
a picture of why costs are going up so high and what we have to do for 
our doctors to help them deliver better care.

  One of the things that we haven't talked about in the bill is an 
important investment in cost-saving measures like medical information 
technology. Currently, many of our doctors, most of our doctors and 
hospitals, are dealing with paper records. They're dealing with paper 
records and there is not a coordination of records. It has led to less 
quality of care than we could have. And what we are going to do in this 
bill is make significant investments in information technology that 
help all our doctors and our hospitals deliver better care.
  Now, my mom is 83 years old. The last time I talked to her, she was 
up to about six different doctors for her various needs and ailments. 
As far as I can tell, she has to walk from office to office carrying 
her records and her x rays and her pills in bags under her arm, trying 
to tell one doctor what the other doctor said or did, and you can see 
in there the kind of problems that our current system has.
  We have the ability to make an investment in medical records 
technology, which is going to deliver better care for everybody. It's 
an important part of the bill, and it's one of the things that has to 
happen to bring our system into the 21st century.
  We're going to protect privacy. We're going to preserve patient 
confidentiality. But we are going to make the necessary investments to 
bring the medical records technology into a place where we reduce 
medical errors, which reduces costs for everybody and improves the 
quality of care throughout our system. It's a very important component 
of this bill. And I can't begin to think that my colleagues on the 
other side of the aisle would object to making that kind of investment, 
because in the end, when we invest in health care reform and health 
insurance reform, two different things, by the way, when we invest in 
health care reform and health insurance reform, we save billions and 
billions and billions of dollars over time because the system, as it 
is, is unsustainable.
  There are investments we have to make to make sure that our economy 
thrives and that we deliver choice, we deliver better care and better 
quality, and we put the American people in control of their own health 
care with a stable and secure system. That means they can't get thrown 
off their insurance. They'll have access to the medical care they need 
when they need it. It will be portable and affordable. And those are 
the hallmarks of a system that will help this country's economy thrive 
and, I dare say, is perhaps the single biggest economic boon we can 
deliver to businesses large and small, reduce our deficit, and keep us 
competitive in the global economy.

                              {time}  2100

  Mr. PERLMUTTER. I thank you, Mr. Hodes.
  And just for me, I would like to wrap up this way: that this is a 
system where there are parts that are broken, there are parts that are 
working, and there are parts that haven't been addressed in a long 
time. We're going to fix what's broken, we're going to keep--and to the 
degree we can--improve what's been working, and we're going to work on 
ways to make Americans or help Americans be healthier and to have 
research that directs them towards better cures and prevention of very 
difficult illnesses, whether it's heart disease or cancer.
  This is a tough subject that we have tackled, but we're not going to 
shy away from it. We can't. Change is what has been demanded of us. The 
system requires change. The status quo is not an option. We will tackle 
this, and we will make this better, and we're going to do it right now. 
There is no more time to waste--as much as our friends on the 
Republican side of the aisle would like to just avoid this at all 
costs. The trouble is it's costing America too much, and we will take 
it on.
  With that, to my friend in Connecticut to wrap it up.
  Mr. MURPHY of Connecticut. Thank you.
  Thank you to Mr. Hodes, Mr. Welch for joining us down here for this 
hour.
  Listen, I think we have heard loud and clear from the businesses we 
represent, from individuals, from doctors, from hospitals: Things need 
to change.
  Just take this one last statistic home with you. If we do nothing, if 
we allow the status quo to continue, within 30 years health care costs 
will consume almost half of every dollar spent in this country--every 
dollar that businesses are spending and individuals are

[[Page H10500]]

spending and the government is spending. That is ruinous for this 
Nation. That course cannot stand.
  So I hope that as we debate this over the coming weeks and coming 
months that we can have some coming together here, we can agree on the 
bottom lines of health care reform, get coverage to people who don't 
have it, and lower costs to everybody. And we will shut out the people 
who scream government takeovers and death panels and all of the rest. 
All of the people either inside this building or outside this building 
whose agenda is to either stop health care from happening or to score 
political points shouldn't have a place at the table. But anyone who 
wants to have an honest debate about how we make the system work better 
for people we represent I think should be there. I think that's 
something we can all come together on.
  I thank my colleagues for joining us this evening. We will be back as 
much as we can.

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